RESUMO
AIM: The effect of remote ischemic preconditioning (RIPC) in decreasing renal ischemia-reperfusion injury (IRI) during a suprarenal aortic cross-clamping was examined in a swine model. MATERIALS AND METHODS: Four groups of pigs were examined: (a) ischemia-reperfusion (IR) group, renal IRI produced by 30 min of supraceliac aortic cross-clamping; (b) RIPC I group, the same renal IRI following RIPC by brief occlusion of the infrarenal aorta (15 min ischemia and 15 min reperfusion); (c) RIPC II group, the same renal IRI following RIPC by brief occlusion of the infrarenal aorta (3 cycles of 5 min ischemia and 5 min reperfusion); (d) sham group. Renal function was assessed before and after IRI by examining creatinine, neutrophil gelatinase-associated lipocalin (NGAL), TNF-α, malondialdehyde (MDA), cystatin C and C-reactive protein (CRP) from renal vein blood samples at specific time intervals. RESULTS: Both RIPC groups presented significantly less impaired results compared to the IR group when considering MDA, cystatin C, CRP and creatinine. Between the two RIPC groups, RIPC II presented a better response with regard to CRP, NGAL, TNF-α, MDA and cystatin C. CONCLUSIONS: Remote IR protocols and mainly repetitive short periods of cycles of IR ameliorate the biochemical kidney effects of IRI in a model of suprarenal aortic aneurysm repair.
Assuntos
Injúria Renal Aguda/prevenção & controle , Aorta Torácica/cirurgia , Precondicionamento Isquêmico/métodos , Rim , Traumatismo por Reperfusão/prevenção & controle , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/fisiopatologia , Animais , Aorta Torácica/fisiopatologia , Proteína C-Reativa/metabolismo , Constrição , Cistatina C/sangue , Mediadores da Inflamação/sangue , Rim/metabolismo , Rim/fisiopatologia , Lipocalinas/sangue , Masculino , Malondialdeído/sangue , Modelos Animais , Fluxo Sanguíneo Regional , Traumatismo por Reperfusão/sangue , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/fisiopatologia , Suínos , Fatores de Tempo , Fator de Necrose Tumoral alfa/sangueRESUMO
BACKGROUND: Thoracoabdominal aortic aneurysm open surgery is accompanied by a significant incidence of renal failure due to renal ischemia. The effect of remote ischemic preconditioning (RIPC) in renal ischemia/reperfusion (IR) injury during a thoracoabdominal aortic aneurysm open repair approach was examined on an animal model. MATERIALS AND METHODS: Three groups of rats underwent the following operations respectively: (a) Sham operation in control group; (b) Renal IR injury produced by subphrenic aortic cross-clamping (45/45 min IR), in IR group; (c) The same renal IR injury following RIPC produced by a brief occlusion of the infrarenal aorta (15/15 min IR) in RIPC group. Levels of lactate, base excess, and malondialdehyde (MDA) were measured in selective blood samples from the left renal vein, while levels of MDA were measured in samples of kidney tissues. RESULTS: Renal blood base excess was significantly reduced in IR and RIPC groups as compared to sham group, but it was significantly higher in RIPC compared to the IR group (-7.69 +/- 0.62 versus -15.15 +/- 0.86, P < 0.001). Renal blood lactate was significantly increased in both IR and RIPC groups as compared to the sham group, but it was significantly lower in RIPC group compared to IR group (6.76 +/- 0.19 versus 11.99 +/- 0.33, P < 0.001). Renal blood MDA was increased in both IR and RIPC groups compared to the sham group, but it was significantly less compared in the RIPC group compared to IR group (1.55 +/- 0.38 versus 2.94 +/- 0.16, P = 0.002). Finally, kidney tissue MDA was increased in both IR and RIPC groups versus sham group, but it was significantly lower in RIPC group compared to the IR group (5.92 +/- 0.82 versus 13.98 +/- 2.41, P = 0.005). CONCLUSIONS: RIPC induced by a temporary infrarenal aortic occlusion decreased the IR renal injury caused by subphrenic aortic cross-clamping.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Precondicionamento Isquêmico/métodos , Complicações Pós-Operatórias/prevenção & controle , Traumatismo por Reperfusão/prevenção & controle , Animais , Aorta Abdominal , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Torácica/metabolismo , Modelos Animais de Doenças , Concentração de Íons de Hidrogênio , Ácido Láctico/metabolismo , Masculino , Malondialdeído/metabolismo , Complicações Pós-Operatórias/metabolismo , Ratos , Ratos Wistar , Insuficiência Renal/prevenção & controle , Traumatismo por Reperfusão/metabolismo , Instrumentos Cirúrgicos , Artérias Torácicas , Procedimentos Cirúrgicos VascularesRESUMO
Liposarcoma is the most common soft tissue sarcoma in adult life while esophageal liposarcoma is an extremely rare tumor. In the world literature, only 14 cases of esophageal liposarcomas have been described. We report a 72-year old male patient who was urgently admitted to our hospital for acute epigastric pain with a burning retrosternal sensation, persistent nausea, vomiting and dysphagia. Barium swallow, upper gastrointestinal (GI) endoscopy, esophageal manometry and CT scan, failed to accurately diagnose the lesion. After surgical resection of an esophageal polypoid tumor, the histological examination revealed a well-differentiated grade I liposarcoma. Diagnostic and therapeutic tools were discussed and the results of literature were reviewed.